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Supero Healthcare Solutions Provider Enrollment and Credentialing Blog

Provider Enrollment - Tips for Success - CAQH (Step 3)

Posted by Brian Agnew on Fri, Jun 10, 2011 @ 16:06 PM

CAQH, Provider EnrollmentOne area that seems to cause confusion during the provider enrollment or credentialing process is CAQH registry. First, let's understand what CAQH is:

The Wikipedia definition: The Council for Affordable Quality Healthcare is a non-profit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives. CAQH strives to be a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers.

Under the CAQH umbrella you have the Universal Provider Datasource (UPD).

The UPD is built around a single electronic form and secure database, this system enables healthcare providers to submit, store, update and access their most critical information for credentialing, claims processing, quality assurance and member services, such as directories and referrals. Payors authorized by providers participating in UPD can electronically download the information into their systems. This standard form meets the data-collection needs of health plans, hospitals and other healthcare organizations.

More than 890,000 providers in all 50 states and the District of Columbia and over 550 health plans, hospitals and other healthcare organizations currently use the service to streamline data-collection processes.

Bottom line is that it is a requirement if you are a professional seeking to become enrolled, credentialed, or contracted with many of the larger insurance carriers.  It is simply a place where all your information resides so that payers can access it whenever they need to.

Being registered with CAQH is a process that is ignited once you have started contacting payors.  Many require that you be registered with CAQH and normally you will receive a special CAQH registration kit provided by the payers, so that you may register on the CAQH website.  Without this registration kit, you can't register, so you need to ask for this when you first make contact with one of the larger health plans.

Once you receive this registration kit you can then proceed to the CAQH website and start the registration process.  You will need to ensure that you give the health plan access to your records. There is a question or two that allows you to authorize access and if you don't complete this step, it could delay the process.

You will normally fill out a separate provider questionnaire or request for participation in a payer network.  Once this is submitted and you are registered with CAQH, the payer can obtain all your credentialing information and then you are off to the races!

If you need assistance in CAQH registry, click here to contact our office today!

Next up - NPI Numbers!

Brian Agnew is President of Supero Healthcare Solutions a leading practice management company focused on provider enrollment and credentialing services for physicians and other healthcare providers.


Topics: Provider Enrollment, Payor Contracting, Payor Credentialing, Provider Enrollment Services, Physician Credentialing, Medical Credentialing, Managed Care Contracting and Credentialing, Credentialing